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Saturday, August 3, 2002

Elderly Patients Not Likely To Recover
NewsRx.com - July 31, 2002
Elderly people with depression have poor chances of full recovery, especially if they are older than 75, according to a study published in the July 2002 issue of the Archives of General Psychiatry

Over a 6-year period, Aartjan T.F. Beekman, MD, PhD, from Vrije University in Amsterdam, and colleagues studied the natural history of depression among elderly men and women ages 55-85. According to background information given in the article, depression is a common disorder among the elderly but has not been well-studied. In order for treatments to be effective, psychiatrists must understand the natural history of late-life depression.

Beekman and colleagues studied data from 277 participants in the Longitudinal Aging Study Amsterdam, a 10-year study of the elderly in the Netherlands. Patients chosen were previously diagnosed with depression. The average age for participants was 71.8 years and about 65% were female.

Interviews were conducted at the beginning of the study, at 3 years and at 6 years. In between interviews, participants completed questionnaires sent through the mail every 5 months for the first 3 years and every 6 months for the last 3 years. At each interview, the participants' form of depression was identified using the Diagnostic Interview Schedule, a common test in epidemiological research of the elderly. Four types emerged: subthreshold depression (207 participants), dysthymia (a mild, chronic form of depression) (25 participants), major depressive disorder (MDD) (23 participants), and a combination of dysthymia and MDD (22 participants).

An analysis of remission in the four diagnostic subgroups revealed that people with subthreshold depression were most likely to have recovered by the end of the study. Those with a combination of dysthymia and MDD faced the most serious prognosis - few elderly people who were diagnosed with this disorder recovered within the 6-year period. Also, those who were 75-85 years old at the beginning of the study had more severe and persistent symptoms than younger participants.

After analysis of the severity and duration of symptoms over the 6-year period, the researchers found that 23% of participants had true remissions, 12% had remission with a few recurrences, 32% had more than one remission followed by a persistent recurrence of symptoms, and 32% had chronic depression. Totals don't equal 100 due to rounding, the authors stated in the article (Arch Gen Psych, 2002:59:605-611).

"The implications of the study are that the burden of depression for elderly persons in the community is even more severe than previously thought," the authors concluded. "The data clearly demonstrate the need for interventions that are helpful, acceptable and economically feasible to be performed on a larger scale." This article was prepared by Pain & Central Nervous System Week editors from staff and other reports.